1st World, congress on Migration, Ethnicity, Race and Health   Internal Migration and Health: A Review of Policies and Initiatives in Low and Middle Income Countries (LMICs) 1st World, congress on Migration, Ethnicity, Race and Health Diversity and Health EICC, Edinburgh 17-19 May 2018 Dr. Anjali Borhade Research Scholar, Nuffield Department of Population Health, Oxford University, Oxford, UK Expert Advisor, WHO SEARO Director, Disha Foundation, India

Literature Review Objectives : To gain an understanding of the : State of urban migration in low, middle and high income countries Healthcare services and healthcare needs of urban migrants Policies to protect and promote the health of urban migrants

Definition of Study Population Migrant workers - Voluntary internal labour migration for paid work Within the country - interstate and intrastate Both permanent (residing in undeclared urban slum areas) and seasonal and circular migration (for 1-12 months in a year) from rural-semi urban, rural-urban, urban-urban areas of India, Who do not have legal citizenship of destination cities.

Literature Review Databases searched Pub Med, Medline, Google Scholar, Advanced Google, Popline by K4 Health Grey literature Papers, reports from various agencies, regional forums and international conference proceedings, country official websites and government publications were also identified.

INCLUSION & EXCLUSION CRITERIA Inclusion criteria: English Primary empirical studies matching the objectives of the literature review between 1970 to 2014 Reports of conferences/ meetings matching the objectives of the literature review Related to labour migrants who make the move for livelihood, within their countries. Exclusion criteria: Studies focusing on the following groups were excluded: - International professional migrants - Internal professional migrants (within country) - Refugees/asylum seekers The review is presented as a narrative synthesis of published empirical research and grey literature. INCLUSION & EXCLUSION CRITERIA

Keywords Low, middle, high income countries and Health policies for internal migrants, Health care for internal migrants, social inclusion of internal migrants, health problems faced by internal migrants, policies for improvement of health of internal migrants, health of migrant women and children, health of migrant workers, social inclusion policies for internal migrants, rural – urban migration and primary health care for internal migrants. These keywords were used in combination with different low and middle and high income countries according to the World Bank’s classification of countries.

Figure 1: Flow Chart of Literature Review in low and middle income countries

Figure 2: Flow Chart of Literature Review in high income countries

Figure 3: Flow Chart of Literature Review in India

Literature Review – Key Findings Literature Review is divided into three parts 1. Low and Middle Income Countries internal migration is prevalent in LMICs. Majority of the LMICs have started addressing migrants’ social security and health needs. Examples include – Sri Lanka, China, Ghana, DRC Congo, Cameroon, and Vietnam 2. High Income Countries internal migration is not an issue for high income countries, though it takes place, migrants do not face exclusion from social security services due to universalization of the social protection services including health. 3. India: Currently no comprehensive policy on internal migration, but fragmented policies for the protection of migrants do exist Recently launched National Urban Health Mission plans to cover migrants in health programs, but no framework exist.

Key Findings in LMICs Country Policy Initiatives Sri Lanka China Sri Lanka National Migration Health Policy is developed for internal and international migrants, adopted evidence-based & multi- stakeholder approach for promotion of the right to health for internal, in-bound and out-bound migrants and their families left behind in Sri Lanka. China No comprehensive migration policy exists. Reform of Hukou system –registration of urban and rural migrants Vietnam No comprehensive migration policy exists. Special efforts made to build a database on internal migration from 2009 census

KEY FINDINGS Country Policy Initiatives Thailand Mongolia National Migration Policy exist but missing sharp focus on internal migrants. Policy emphasis with holistic and multi-sectoral approach for improving health of migrants laying emphasis on social and environmental determinant. Universal coverage of health security has introduced through social security and universal coverage schemes (UCS) to improve access of migrants to health care services Mongolia No comprehensive migration policy exists. Reach Every District (RED) strategy adopted for outreach to cover mobile and unregistered remote migrant population for improved access to immunization, maternal and child health and other health services

KEY FINDINGS Country Policy Initiatives Philippines Malaysia No comprehensive migration policy exists. Presence of a legal framework for protection of migrants and IDPs, coordination between different departments, formation of human resource for Health Network- a multi-sectoral organization, special initiatives for migration and HIV, portable national health insurance Malaysia No comprehensive migration policies exist. Mandatory HIV Testing, Emphasis on accessibility to health care services in terms of physical, economic & information criteria Vision of Malaysian Govt. Two tier health system with rural clinics & hospitals at district, state & centre level.

KEY FINDINGS Country Policy Initiatives Cameroon Ghana No comprehensive migration policy exists. Framework for the Proactive Governance of Internal Migration (F-PGIM) is set up with the goal of transforming internal migration into an engine of balanced national development and equitable and sustainable human development. Ghana Recent Creation of a National Migration Bureau (NMB)- an inter-ministerial committee later renamed as Migration Unit (MU)-task is to formulate National Migration Policy to mainstream migration into development plans Democratic Republic of Congo (DRC) No comprehensive migration policy exists. But efforts are made by National Government to incorporate migrant health into its overall programs and policies associated with the reform Strategy of the Ministry of Public Health

KEY FINDINGS Country Policy Initiatives India Currently no comprehensive policy on internal migration exists. Comprehensive migration support program for tribal migrants in Maharashtra state started in 2013, to be soon extended in other tribal states of India Interstate Migrant Workers Act 1979 provides comprehensive protection and welfare services to inter-state migrant workers

KEY FINDINGS Country Policy Initiatives India Few states of India offers state health insurance to migrants Portable National health insurance program ‘RashtriyaSwasthaBimaYojana’ is available. Integrated Child Development Scheme provides health care services to migrant women, children and adolescents at destination cities.

KEY FINDINGS Country Policy Initiatives India National urban health mission 2013 plans to cover migrants in the health programs. Jharkhand and Rajasthan states have made provision for registration of out-migration at source areas.

Policy Gaps Government policies and institutional measures are limited by the perception of that free migration is harmful LMICs where migration health policies exist, they operate in isolation at national levels Disconnect between policy and practice. Policy measures are not backed by the requisite research and evidence Resources are rarely being directed at mobile and displaced populations and their needs are not addressed in national strategies and action frameworks

Policy Gaps Policies overlook the human cost both of migrants and their families Another major gap is in the form of implementation and regulation of laws, policies and programs

Moving the policy discourse on migrant health – from piecemeal efforts to whole government approach Multi-sectoral approach is crucial to address diverse needs of migrants Formation of a nodal agency and focal point for welfare of internal migrants Formation of a database on internal migrants and development of an effective tracking system to counter their mobility Universal coverage of health and social security program (social insurance, education, livelihood training, and housing) is crucial for migrants to get seamless access before and during their migration Increase participation of migrant communities, migrants unions, and civil societies for pro-migrant policy formulations and implementation

Looking forward to learn from questions, comments and inputs Thank you Looking forward to learn from questions, comments and inputs